Unlimiting the Mind

Andrew Olendzki's book, Unlimiting Mind (2010) is the first text we will read in this year's study group in mindfulness and psychotherapy.  Olendzki is one of the foremost American teachers of Vipassana, a Buddhist school which emphasizes mindfulness.  His writing is wonderfully clear and he makes some of the ancient Buddhist texts and ideas very accessible.

For the next meeting of the study group (October 8), I'm recommending that we focus on the sections that are most directly related to Buddhist psychology and the underpinnings of mindfulness: section 4, "The Practice;" section 5, "Understanding the Teachings;" and section 8, "The Emergence of Mindfulness".

Olendzki has chosen a great title for this work, because it addresses the central question of Buddhists and psychologists alike.  How do we get free of the limitations which stand between us and a fulfilling, worthwhile life?  Olendzki turns to ancient Buddhist sources (the scriptures recorded in the Pali language about 300 years after Buddha's death) for his answer, and so gives us a window into the wisdom and traditions that have preserved mindfulness to this day.  He writes insightfully about the conditioning which leads all of us to go through our lives on automatic pilot, concerned primarily with how to accumulate the things we like and get rid of the things we dislike.  We are hardly aware of the psychological processes that restrict our happiness, and Olendzi's great contribution is to make those mental functions accessible to our western consciousness.

One very interesting approach to Unlimiting Mind is to read it while reflecting on our modern applications of mindfulness.  It is especially illuminating to consider the connection between values and mindfulness in Acceptance and Commitment Therapy (ACT) while reading Olendzki's account of "Changing your mind" in section 4.  Also, in section 5, Olendzki discusses one of my favorite concepts from Buddhist psychology: Papanca.  Referring to our tendency to "mentally proliferate" on our experience, and to become absorbed in our reactions to the point of being completely out of touch with our basic experience, papanca is the Buddhist forerunner of ACT's core concept of cognitive fusion.

I'm hoping that reading Unlimiting Mind will develop a familiarity with Buddhist psychology that will help us see the roots of the ACT processes that were rediscovered though Relational Frame Theory.   I'm looking forward to a stimulating and wide-ranging discussion on October 8th.

ACT and Personal Coaching

Many of the individuals and couples we see in our practice are dealing with life problems that transcend medically-based diagnostic categories. These issues are not symptoms of larger problems like clinical depression, but the natural expression of our complicated human lives. Most of the time, our problems are just the result of our efforts to get through life as best we can - efforts which have had both positive and negative outcomes.

Despite the differences between psychotherapy and personal coaching, we have found that our training and experience as clinicians can be a tremendous benefit to our personal coaching clients. Not the least benefit is the fact that effective psychotherapists know that a great deal of our suffering comes from the fact that we are simply participating in the human condition (remember the first noble truth?).

I recently ran across a quote on Kelly Wilson's website that nicely articulates the humanism and far-reaching egalitarianism that underlies Acceptance and Commitment Therapy:

ACT does not allow a neat division between people doing treatment and people needing treatment. It is hard to get what is important about ACT without confronting the fact that in a very deep sense, we are all in the same boat. This means that the principles are scalable. ACT addresses obstacles to effective living that transcend diagnostic categories and even the notions of "sick" and "well." ACT attempts to address very fundamental issues that affect us all.

I've always been impressed by the totally non-pathologizing basis of the ACT approach. Its basic assessment categories are about skills and abilities, rather than diagnostic labels. We have found that ACT techniques are a powerful addition to our personal coaching services as well as a basis for psychotherapy. Here are some of the principles that we believe are central to positive change in both psychotherapy and personal coaching, starting of course with:

Acceptance and Commitment. Our coaching strategies rely on this fundamental principle, which we have learned through many years of helping people in psychotherapy: Meaningful change always requires both a thorough acceptance of ourselves as we are, and a commitment to act in accordance with our deep personal values. This is the basis of the ACT approach to psychotherapy.

Positive psychology figures prominently in both our psychotherapy and our personal coaching program. We have learned that happiness is not really the result of things that happen to us, but can be cultivated in the way we engage our lives. We draw on the growing body of psychological research on this topic to help people live more satisfying lives and realize their potentials.

Mindfulness is what enables us to be in the present, the place in which all change occurs. In taking action which actualizes our most far-reaching goals, the only thing we can ever do is take one step from right here. It can be startling to realize how much of our time we spend in daydreams and preoccupations, completely out of contact with our real life. Mindfulness helps us orient to who we really are, and what we are really experiencing. With this perspective, the path to our personal and professional goals is much clearer.

We've written a bit more about Integrative Health Partners' Personal Coaching Program on our website. Feel free to visit and browse.

Every Day a Gift

This week in our study group on mindfulness and psychotherapy, we were discussing mindfulness of the body. In the Buddhist Sutra on the Four Establishments of Mindfulness, there is an instruction to contemplate the mortality of the body. The meditator is asked to envision the decomposition of a human corpse, holding the realization that his own body is of exactly the same nature, and there is no way for it to escape that fate. On one level, it seems to be the ultimate meditation on both impermanence and “impurity,” encouraging sobriety and a measure of detachment from the endless round of desire that we live in most of the time. It is easy to imagine this meditation as effective in controlling sensual cravings and helping monks uphold their vows of celibacy. And yet, this purpose seems much more appropriate to the homeless monks of India in 500 BCE than to ourselves as twenty first century psychotherapists and clients. During our discussion in the study group on Friday morning, the question arose: what possible value could this mindfulness practice have for us as therapists? Could it find its way into a therapeutic dialog, and if so, in what form?

Some of us realized that, as challenging as it was, we have derived great benefit from the encounters we have had with of our mortality. Those of us who have been cured of serious illnesses, or narrowly escaped terrible injury in an auto accident, have found in these experiences a certain clarification of what is important, what is heartfelt in our lives. We all know (or are!) people who, after a serious diagnosis, have made real changes in our lives. Our awareness of mortality gives us another perspective from which to ask the question, "What is the most important thing?"

So how does a meditation on death enter into the therapeutic dialog? Mostly, I think, more subtly than in the Mahasatipatthana Sutra. One member of the study group (NR) pointed out that in Native American shamanist traditions, using death as an advisor is a recommended practice. Essentially the same point is made in a Zen monastery, where the instrument that is used to call the monks to meditation is often inscribed with a verse like: "Life and death are serious. Gone is gone. Wake up! Don't waste time."

We do not necessarily notice it, but actually, mortality is a natural part of the discussion whenever we take up the question of how we live our lives, whether in psychotherapy or elsewhere. Questions like “What should I do next…” take on a much deeper meaning when we finish them “…given that my time in this life is limited.” Conventionally, we agree to suppress our mindfulness of this part of the discussion, but it’s worthwhile to consider whether in doing so we are depriving our clients of an important source of meaning and motivation.

Consider this typical statement from the viewpoint of Acceptance and Commitment Therapy:

We explain to clients that the perspective we work from seeks to understand people’s difficulties in the context of a whole life. Sometimes problems become so overwhelming that it is easy to lose contact with the “big picture.” We do want to know how the client has struggled, but seek an understanding of that struggle in the context of a whole person with hopes, desires and aspirations. (Wilson and Murrell, 2004, p. 136)

In this formulation, our mortality lurks just outside the frame of the intervention. The “context of a whole life” inevitably includes the limited nature of that life, whether we choose to recognize it or not. It’s quite possible that Wilson and Murell’s statement could naturally open the door to a discussion of how our impermanence contributes to the quality of our actual presence in life. In fact, it is arguable that such an investigation can be avoided only by the active suppression of awareness.

That discussion would naturally take on different dimensions with different people. But it is frequently found that one outcome of increased awareness of the impermanence of this life is the commitment to pay attention while we are still living. As Mary Oliver says in her poem “When Death Comes,” “I don’t want to end up simply having visited this world.” In some paradoxical way, the reality of the end of life brings us into our lives with awareness, vigor, and appreciation. It is somewhat hard to imagine a context for therapeutic change that does not mobilize this type of engagement.

In my mindfulness and stress reduction classes, one question I have used to good result is: "If life could be about something, what would you want your life to be about?" (see also Wilson and Murrell, 2004, p. 135). This discussion is a critical support to the development of mindfulness practice. No one ever says, “I’d like to find a way to sleep my life away.” Instead, people talk, for example, about wanting to develop their mindfulness so they can pass a deep appreciation of life on to their children. For people to undertake such an unconventional practice as mindfulness, there must be a good reason, and that reason must be consciously affirmed. To remind ourselves of Jon Kabat-Zinn’s basic insight, mindfulness is a deliberate attention.

Occasionally, when my wife and are walking with our mobility-challenged twelve year old golden retriever, she will remark: “Each day with Bailey is a gift.” Inevitably, we are put in touch with our appreciation of and gratitude for the opportunity to have this walk together. It is really worthwhile to pay attention to this moment when we recognize it as irreplaceable.

One insight from the Mahasatipatthana Sutta is that mindful awareness is nurtured by the awareness of life’s actual and limited nature. In the psychotherapeutic field, this tenet has so far been the rather exclusive province of the Existential therapies. Possibly, with the support of those ancients who devoted their lives to mindful awareness, the mindfulness-oriented therapies will take a second look at this basic observation, and consider whether it can be cultivated to therapeutic effect.

Note: to see a draft of the Wilson and Murrell paper mentioned in this post, click here. The reference for the final version is:

Wilson, K. G. & Murrell, A. R. (2004). Values work in Acceptance and Commitment Therapy: Setting a Course for Behavioral Treatment. In Hayes, S. C., Follette, V. M., & Linehan, M. (Eds.) Mindfulness & Acceptance: Expanding the cognitive-behavioral tradition (pp. 120-151). New York: Guilford Press.

Sutra on Mindfulness

In our study group on mindfulness and psychotherapy, we've been asking the question, "What do the original sources tell us that will help us integrate mindfulness into psychotherapy?" I thought it would be good to make the most important sutra on mindfulness available here. This is the Mahasatipatthana Sutta, often translated as "The Four Foundations of Mindfulness," although the title also has more subtle meanings. Maha means "great." Sati means "mindfulness," but it also has the connotation of "remembering." The term uppathana refers to a process of repeated penetration. Sutta is a buddhist teaching. So the Mahasatipatthana Sutta is the great teaching about entering mindfulness time and time again, or I suppose we could say "the teaching on mindfulness practice."

At any rate, here are some translations available on the web. Enjoy your reading!

http://www.accesstoinsight.org/tipitaka/dn/dn.22.0.than.html
http://www.basicbuddhism.org/index.cfm?GPID=47#Breathing
http://www.buddhanet.net/e-learning/mahasati.htm

Mindfulness and Dieting

All we have to do is consider losing five pounds, and we are confronted with dozens of theories of weight loss and hundreds of diets. A lot of them seems plausible, and some of them almost seem doable. The one thing nearly all of them lack is a statement at the end: "If you try to follow this plan exactly, you will probably end up gaining weight instead of losing weight." This is the unfortunate truth. Chronically being "on a diet" is not usually a good thing for one's weight. Efforts to rigidly follow a diet are often a set-up for failure, and failure is often a set-up for eating out of frustration and self-hatred.

In fact, it's difficult to imagine that any generalized diet could actually dictate all of the choices we need to make to eat in a healthy way. For one thing, relying on an external source to regulate our eating deprives us of the most important factor in developing a healthy diet: our inner wisdom.

We often rely on some external program because we do not trust ourselves to be guided by that inner wisdom. This is not a new problem. We have a record of a Chinese Zen teacher in the tenth century saying to the people who had gathered to hear his talk, "If you continue to seek the truth in someone else's mouth, when will you ever have today?" A thousand years ago, it was pretty clear that seeking outside oneself was a good way to become estranged from the here-and-now source of well being that most of us would like to cultivate. The same is true today about many of the things we seek, including a balanced and healthy approach to eating.

Diets aside, human beings are able to access an essential way of regulating weight: we can learn to eat when we are hungry and stop when we are full. We can let ourselves be guided in our food choices by all of our sources of knowledge: about nutrition, health, our hunger, and our preferences in the moment. We can eat in a way that lets us enjoy and appreciate our food and our ability to nourish ourselves. Quite importantly, we live in a culture in which most of us can be sure of our next meal, and so we are not driven to gorge ourselves because of realistic fears of scarcity. We can stop eating when we are satisfied, secure in the knowledge that we can eat more later, when we are hungry again. The hyperavailability of food in modern western societies, while terrifying and tempting to dieters, can be a source of reassurance and security to self-guided eaters, lowering the biological need to eat past the point of satiety. There's more where that came from!

The self-guided "diet" really depends on our ability to know ourselves, to be able to tell the difference between physical hunger and emotional hunger, and to have the wisdom to respond skilfully to both. Our dieter's tendency to ignore and suppress moderate levels of hunger ("It's not time to eat yet!") only guarantees that when we do eat, we will have to deal with the pressure generated by distressingly high levels of hunger.

To be self-guiding, we also have to pay attention while we are eating and know when we are starting to get full. We have to be open to all the pleasures that are inherent in eating - tastes, textures, aromas, companionship, feelings of being nourished - so that we can actually feel satisfied with our food.

In other words, to be self-guided in our diet, we need to develop our mindfulness. Eating with full awareness, but without judgment, allows us to guide ourselves in sensible ways. And this is exactly what mindfulness cultivates: our ability to be compassionately aware of ourselves, our experience, and our environment. With mindfulness, we have a tool that is absolutely essential to healthy eating.

Meditation, Anxiety, and Depression - Part I

I've given a lot of thought to how mindfulness meditation can be helpful in dealing with psychological problems like anxiety and depression. In this and subsequent posts, I'd like to share some of these ideas with you. Let's start with a look at the mental activity that goes into mindfulness meditation.

Meditation, as a psychological process, is pretty interesting. A typical approach is to be mindful of the breath: just let your attention go to the physical experience of breathing. When the attention wanders away from the breath, simply notice that you have been thinking or daydreaming (or whatever) and then, gently and without self criticism, bring your attention back to the breath. Even in the process of guiding your attention back to the breath, maintain an attitude of acceptance toward all of your experiences.

Even though these instructions are pretty simple, they actually involve training ourselves in some very important psychological processes. In mindfulness meditation, we are:

learning to recognize and relinquish the mental states we become absorbed in

treating ourselves with gentleness and compassion

learning to settle and be accepting of ourselves and our experiences

developing our ability to have a negative experience without being overwhelmed or panicked by it

Later, I'll write in detail about how these skills relate to the mental states that generate and sustain depression and anxiety, but for now I invite you to ask yourself this question: Do these qualities sound like risk factors for depression or protective factors against it?

Well-being and Mindfulness Practice

This study confirms what we have found in all of our mindfulness classes: people who put more time and energy into their mindfulness practice benefit the most.

Carmody J and Baer RA (2007) Relationships between mindfulness practice and wellbeing J Behav Med., Sep 25

Relationships were investigated between home practice of mindfulness meditation exercises and levels of mindfulness, medical and psychological symptoms, perceived stress, and psychological well-being in a sample of 174 adults in a clinical Mindfulness-Based Stress Reduction (MBSR) program. This is an 8- session group program for individuals dealing with stress-related problems, illness, anxiety, and chronic pain. Participants completed measures of mindfulness, perceived stress, symptoms, and well-being at pre- and post-MBSR, and monitored their home practice time throughout the intervention. Results showed increases in mindfulness and well-being, and decreases in stress and symptoms, from pre- to post-MBSR. Time spent engaging in home practice of formal meditation exercises (body scan, yoga, sitting meditation) was significantly related to extent of improvement in most facets of mindfulness and several measures of symptoms and well-being. Increases in mindfulness were found to mediate the relationships between formal mindfulness practice and improvements in psychological functioning, suggesting that the practice of mindfulness meditation leads to increases in mindfulness, which in turn leads to symptom reduction and improved well-being.